Affidavit Of Adviser Activity In Arizona

NO INVESTMENT ADVISER ACTIVITY IN ARIZONA I, ________________________________________________________, a principal with (Name of Principal) ____________________________________________________________ (the IA Firm), have (Name of Investment Adviser) conducted a review of the IA Firms records. The result of this review shows that investment adviser activity has been conducted with ______________ Arizona residents prior to the IA (Number of accounts) Firms licensure as an Investment Adviser with the state of Arizona. Attached is a list of all investment adviser activity conducted with Arizona residents prior to the IA Firms licensure as an Investment Adviser with the state of Arizona. The list includes the names and addresses of Arizona advisory clients, the amount of advisory fees charged to each Arizona client, description of the advisory services provided, the date of any transactions, the name and amount of any security purchased and price per share/unit, the number of shares/units purchased, the current value of the security purchased, the profits and losses experienced by the clients, and any commissions generated on these offers and sales. If the investment adviser relied upon an exemption for the advisory activity, indicate the exemption relied upon. _______________________ _______________________________________ (Date) (Signature of Principal) Subscribed and sworn to before me this Notarys Seal Here ______ day of __________________, 2_____. _____________________________________ Notary Public My Commission Expires: _________________ Rev. 6/2001